Provider Demographics
NPI:1952455453
Name:RIAHI, REZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:RIAHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2923
Mailing Address - Country:US
Mailing Address - Phone:650-485-2514
Mailing Address - Fax:
Practice Address - Street 1:850 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2923
Practice Address - Country:US
Practice Address - Phone:650-485-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV06249OtherBLUE SHIELD